From the Guidelines
Atrial fibrillation (AF) is most commonly caused by hypertension, coronary artery disease, and heart failure, as well as non-cardiac conditions such as hyperthyroidism, obesity, and obstructive sleep apnea, with acute triggers including surgery, infections, and electrolyte abnormalities, as supported by the most recent study 1.
Causes of Atrial Fibrillation
The causes of AF can be broadly categorized into cardiac and non-cardiac conditions. Cardiac conditions include:
- Hypertension, which creates structural changes in the heart through increased pressure
- Coronary artery disease, which can lead to myocardial ischemia affecting atrial tissue
- Heart failure, which stretches the atria and alters electrical conduction
- Valvular heart disease, particularly mitral valve disorders, which significantly increases AF risk by causing atrial enlargement Non-cardiac conditions include:
- Hyperthyroidism, which increases sympathetic activity
- Obesity, which causes structural and inflammatory changes
- Obstructive sleep apnea, leading to intermittent hypoxia and autonomic disturbances
- Excessive alcohol consumption, especially binge drinking
- Stimulant use, including caffeine, cocaine, and certain medications
Acute Triggers
Acute triggers for AF can include:
- Surgery, especially cardiac and thoracic procedures
- Infections
- Electrolyte abnormalities, particularly hypokalemia and hypomagnesemia
- Significant stress or illness
Importance of Identifying Underlying Causes
Identifying the underlying causes of AF is essential for effective management, as treating the root cause often improves AF control, as noted in the study 1. Additionally, the study 1 highlights the importance of considering drug-induced AF, particularly in patients with a history of AF, pre-existing AF risk factors, or comorbidities that commonly co-exist with AF.
Recommendation
Based on the most recent and highest quality study 1, it is recommended to consider a comprehensive evaluation of cardiac and non-cardiac conditions, as well as acute triggers, to identify the underlying cause of AF and guide effective management.
From the Research
In-Patient Causes of Atrial Fibrillation (AFib)
The in-patient causes of Atrial Fibrillation (AFib) can be attributed to various factors, including:
- Hemodynamic instability, such as decompensated heart failure 2
- Recent onset of symptoms, typically less than 48 hours 3
- Underlying cardiac conditions, such as organic heart disease 4
- Triggering events, such as myocardial infarction or coronary artery bypass surgery 4
Management of AFib in the Acute Setting
In the acute care setting, management strategies for AFib include:
- Determining the trigger of the arrhythmia 3
- Rate control, using medications such as beta-blockers or calcium channel antagonists 3, 4
- Potential cardioversion, either pharmacologic or electrical 3
- Risk stratification for stroke and initiation of long-term anticoagulation in appropriate patients 3
Treatment Options for AFib
Treatment options for AFib depend on the underlying cause and duration of symptoms, and may include:
- Rate control, using medications such as beta-blockers or calcium channel antagonists 5, 6, 4
- Rhythm control, using medications or procedures such as catheter ablation 5, 6, 2
- Anticoagulation therapy, using medications such as warfarin or direct oral anticoagulants 5, 2
- Surgical options, such as disruption of abnormal conduction pathways in the atria or obliteration of the left atrial appendage 5